In 2019, Mutual of Omaha, an Omaha-based insurer will begin selling Medicare Advantage plans with prescription drug coverage. They have partnered up with Lumeris, a St. Louis company that will handle the health provider networks, and healthcare solutions.
The Kaiser Family Foundation recorded that one in three Medicare recipients are enrolled in a Medicare Advantage plan. They project the number to rise to nearly 41 percent by the year 2027.
Omaha is introducing Medicare Advantage Plans in 2019 to provide options for seniors.
The Plan
James Blackledge, the Mutual Chairman and CEO said “Our entrance into the Medicare Advantage market represents a significant step forward for Mutual of Omaha as we strive to respond to customer needs and offer a meaningful suite of senior health solutions. We’re confident that our collaboration with Lumeris will lead to better health outcomes for our Medicare Advantage customers.”
Mutual started in 1909, and has been one of the first providers of Medicare Supplement plans. But recently Medicare Supplement plan sales have been declining, while Advantage sales have increased.
Lumeris has over 10 years of experience with Medicare Advantage plans, even starting their own called Essence Healthcare, which has about 65,000 members in the St. Louis area. They have built a value-based model to provide seniors with better health for a lower cost while providing a better patient and physician experience. The company functions to help other medical providers deliver better care and financial outcomes by its value-based care model.
The idea is to create more plans so that Medicare beneficiaries can save money, and receive better care.
“Our new initiative with Mutual of Omaha is exciting because it enables both of our companies to build on our successes while remaining laser-focused on what matters most—delivering the highest quality care to seniors,” said Lumeris Chairman and CEO Mike Long. “This new partnership also leverages each company’s unique strengths to benefit the larger healthcare ecosystem. Together, we will make a deeper, more meaningful difference in the lives of patients and providers.”
Hopeful Future
The alliance between the companies will allow Mutual of Omaha to continue to lead in the senior health market. Mutual will provide Medicare Advantage plans, while Lumeris will evaluate markets, and establish networks.
A Mutual executive vice president, Brad Beuchler said that the plans will have narrow networks. The networks will be limited as to how many physicians, hospitals and care providers to choose from. This way there will be reduced costs while improving efficiency and medical outcomes.
The multiyear agreement is expected to be ready by Medicare open enrollment October 15, and the plans taking effect January 1, 2019. This will hopefully provide better healthcare quality with lower costs for seniors.
Medicare is making some positive moves in the diabetes field. Not only are they now covering some continuous glucose monitors (CGMs), but they are also beginning to connect it to smartphones. Glucose monitors were not covered by Medicare last year. This left people with diabetes the only option of paying for it out of pocket. If they could not afford it, then they did not get one. These devices help diabetics manage their glucose levels. Now the readings can be transmitted to iPhones.
How A CGM Works
Medicare will begin to cover 2 brands of continuoius glucose monitors.
A sensor is worn on the arm or stomach area, and collects glucose data from under the skin. It will test glucose levels every few minutes and send the results to a monitor. The monitor will either be a part of an insulin pump, or a separate device you can carry. The monitor shows when a person’s glucose is going up, down, or staying steady. They are constantly working, even when the person is showering, working out, and sleeping. These devices will send an alert when the levels are high or too low. The sensors have to be replaced every 3 to 7 days depending on the model.
The Devices Now Covered By Medicare
The two CGM systems Medicare will now cover are Dexcom’s G5 Mobile and Abbott’s FreeStyle Libre. The two systems will be covered for beneficiaries with type 1 and type 2 diabetes. The Dexcom G5 Mobile monitors for up to a week and will send readings to an insulin pump or a wireless receiver such as a phone. This notifies the user when their levels are on the rise, falling, or steady.
The Freestyle Libre collects data up to 10 days from a sensor put into the arm. It will collect the data and the user will have to move a reader device over the sensor to check their levels. This device will show when a person’s glucose level is going up or down, but will not alert the user when it is out of range.
Smartphone Use
You can now connect your glucose monitor to your smartphone to keep track of your levels, and share with your doctor.
Companies like Dexcom were able to develop these monitors the ability to transfer information to iPhones. Having levels sent to a smartphone will help users use the Share app. This app allows the user to share their glucose level information with their doctor and caregiver. However, one of Medicare’s conditions with the Dexcom Mobile device is that it is not covered if the person uses the smartphone app. Dexcom is trying to work things out with Medicare to get it covered.
Continuous glucose monitors were not covered by Medicare just a year ago. Now Medicare has loosened their restrictions, allowing two types of devices to be covered for beneficiaries. The only issue is within the limited conditions that it will not be covered if used with a smartphone. Medicare is currently under pressure by beneficiaries and these glucose monitor companies to come to some sort of agreement. Medicare is in talks with Dexcom. The company and users are hoping that the use of smartphones will be allowed, because it makes tracking levels and sharing them with doctors easier, which helps manage glucose levels.
Medicare Supplement plans are purchased to help relieve some of the burden that Medicare part A & B leave behind in the form of out of pocket expenses. Medicare covers only 80 percent of Part B costs and the 20 percent is left for the individual to pay. Even though it is only 20 percent, it can be too much for a retired person to pay. Because of this, insurance companies decided to create Medicare supplemental insurance plans, to pay for that 20 percent difference to help with finances.
There are 10 different standard Medicare Supplement plans that are sold in most states.These 10 Medicare Supplement plans are A, B, C, D, F, G, K, L, M, N, as well as a high-deductible Plan F option. Not all plans cover the same services.
In general, all Medicare Supplement plans cover at least part of:
Medicare Part A and Part B deductibles
Skilled nursing facility costs (after you run out of Medicare-covered days)
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
Medicare Part B coinsurance or copayment
Part B excess charges
Part A hospice care coinsurance or copayment
Blood (first 3 pints)
Two Medicare Supplement plans (Plan K and L) include an out-of-pocket limit. This means that once you have reached a certain amount spent on Medicare-covered services, the Medicare Supplement plan will cover 100% of Medicare-covered costs for the rest of the year.
An overview of the different Medicare Supplement plans and what they cover.
* There is also a high-deductible version of Plan F.
Some Facts to Know:
All insurance companies that sell Medicare Supplement must offer Plan A. A company must also offer either Plan C or Plan F if it offers any other plan besides Plan A.
Each standard Medicare Supplement plan option must provide the same basic benefits. For example, a Plan A policy sold by a company in California will have the same basic benefits as a company in Pennsylvania selling the same lettered plan.
Plans E, H, I, and J are no longer offered, but if you already have one, you can keep using it until you decide to switch, then you cannot go back.
Not all Medicare Supplement plans may be available in your state. In Massachusetts, Minnesota, and Wisconsin, Medicare Supplement policies are standardized differently.
Standardized Medicare supplemental plans do not provide coverage for dental care, hearing aids, vision care, prescription drugs or long-term care.
You can see any doctor, whether they accept Medicare assignment or not. Medicare assignment is when your doctor or provider accepts the Medicare-approved amount as full payment.
If your doctor accepts assignment, then your Medicare Supplement insurance company will pay your doctor directly.
If your doctor does not accept Medicare assignment, you will have to pay your doctor yourself and send in claims to your insurance company.
Medicare SELECT
In some states you can purchase Medicare SELECT, which is a type of Medicare Supplement policy. Medicare SELECT can be any standardized Medicare Supplement plan (plans A-N). It requires the policyholder to use hospitals and doctors in their network. If it is an emergency, then you will not have to stay in network. Medicare SELECT plans often have lower premiums.
Medicare Part B bills can become overwhelming, so a Medicare Supplement plan is beneficial to sustain the costs. At EZ.Insure we are trained to be on your side and get you the best plan in your budget. Get an instant quote by typing your zip code in the bar above, or speak with someone now. You can contact one of our highly trained agents through email at Replies@EZ.Insure, or by calling 855-220-1144. At EZ.Insure we want to help you get coverage, not help insurance companies get right. We know how hard it is dealing with a ton of phone calls and agents hounding you, which is why we want to help, we work for you. Let us help you today!
Medicare is the federal health insurance program for people who are 65 or older. When you enroll in Medicare, it is important to understand how it works and whether or not you will need a Medicare Supplement plan to go with it. Once you pay your deductible, Medicare covers only 80% of your Part B expenses, leaving you to pay the rest. Medicare Supplement is an insurance plan that is sold by private companies. Medicare Supplement plans help pay for the 20% of the Medicare Part B costs which is left for you to pay.
Original Medicare, and Medicare Supplement plans cover different healthcare. It is important to go over each program, and what they offer in order to determine if a Medicare Supplement plan will benefit you.
How Medicare Works:
Every year, you must pay a set amount, a deductible, for your health care before Medicare pays its share. You can sign up for Part A and/or Part B insurance, but most people have both. You pay a monthly premium for Part B. Medicare only covers 80 percent of Part B services, leaving you with the other 20 percent to be paid out of pocket. Depending on your medical needs in a given year, that 20 percent gap can become a large financial burden.
For 2017, the Medicare Part A deductible is $1,316 a year, while Medicare Part B’s yearly deductible is $183. Once you have paid your deductible in health bills such as physician visits, outpatient hospital services, and covered medical equipment, then Medicare will pay cover the rest up to 80% for Part B, and 100% for Part A.
Medicare will cover annual wellness visits once a month.
What Medicare covers
Medicare benefits are divided into two parts, Part A and Part B.
Medicare Part A (Hospital Insurance)— covers inpatient hospital care, skilled nursing facility care, short-term nursing home care, hospice care, and some home health care. (100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility.)
Medicare Part B (Medical Insurance) — covers annual wellness visits every month, ambulance services, orthotics and prosthetics, medical equipment, and mental health care. (80% of costs covered by Medicare.)
What Medicare does not cover
Annual physical exams except other than one annual wellness visit
Health care you get while traveling outside of the United States (Very limited exceptions)
Hearing aids, and most hearing exams
Long-term nursing home care for more than 100 days
Acupuncture, naturopathy, etc.
Most eyeglasses
Most dental care
Prescription drugs are not covered under Parts A and B, but it will cover some drugs in certain cases like immunosuppressive drugs for transplant patients, and oral anti-cancer drugs. For prescription drug coverage, you should consider signing up for stand-alone Medicare Part D plan.
How Medicare Supplement Works:
There is a monthly premium for your Medicare supplement plan, and in return, the plan pays most of your expenses not covered by Medicare parts A & B. For example, if you have a $4,000 ambulance bill and have already met the yearly Medicare Part B deductible, Medicare Part B will pay 80% of the bill. This leaves you to pay the 20% that us left, $800, out of pocket. But if you have a Medicare Supplement plan that covers Part B copayments and coinsurance costs, then it will pay the $800 remaining.
The Medicare Supplement Open Enrollment period is the six-month period that starts on first day of the month that you are 65 and enrolled in Medicare Part B. During the open enrollment period, you can enroll in any Medicare Supplement plan offered in your service area with guaranteed issue. This means that insurance companies are not allowed to deny you or charge you more due to pre-existing conditions. There are many different types of Medicare Supplement plans to choose from, and they vary in levels of coverage and cost.
What Medicare Supplement covers
Medicare Supplement will cover nursing facility costs after you run out of Medicare-covered days.
In general, all Medicare Supplement plans cover at least part of:
Medicare Part A and Part B deductibles
Skilled nursing facility costs after you run out of Medicare-covered days
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
Medicare Part B coinsurance or copayment
Part B excess charges
Part A hospice care coinsurance or copayment
Blood (first 3 pints)
Some will cover:
Foreign travel emergency (up to plan limits)
Part B deductible
Two Medicare Supplement plans (Plan K and L) include an out-of-pocket limit. Once you have reached a certain amount spent on Medicare-covered services, the Medicare Supplement plan will cover 100% of the costs for the rest of the year.
What Medicare Supplement does not cover
Medicare Supplement policies generally do not cover:
Long-term care (care in a nursing home)
Routine vision or dental care
Hearing aids
Eyeglasses
Private-duty nursing.
Prescription drugs
Looking for more details or help?
There are roughly 10 different types of medicare supplement plans on the market, and they all vary in coverage and cost. Figuring out which plans are best for you can be hard, but we are here to help. If you would like to gather more information on Medicare and Medicare Supplement plans, one or our highly trained agents are ready to help.
You can start by simply entering your zip code in the bar above to get a quote, or you can contact us by email at Replies@Ez.Insure or call 855-220-1144. There is no hassle and no obligation. We will help you answer any questions, go over all of your plan options, find the Medicare Supplement plan most suited for your needs and budget, and even help you sign up if you’re ready. No hassle necessary! We work on your time and do not hound you with calls like the other guys.
